Importance: The nasal tip projection, rotation, and support are essential components to address during rhinoplasty surgery. Objective: To describe a novel combined septal extension-columellar strut autologous cartilage graft for use in rhinoplasty to control tip projection, shape, and rotation while restoring strength to the nasal tip. Design: Surgical pearls-description of a novel surgical technique. Setting: An academic practice. Participants: Patients who underwent the operation.